Drug utilization review is the process of assessment of drugs, consumed by a population, in terms of their efficiency and potential risks, in order to dodge fraud, dangerous interactions and over-prescribing and therefore, inevitable disasters. In every US state, according to the mandates of the Omnibus Budget Reconciliation Act of 1990, many private drug utilization review boards, which supervise outpatient prescriptions for Medicaid patients, work for health insurance or pharmacy companies.
The Drug Utilization Review program, an inventive and computerized system, not only, puts prescription drugs of Medicare Plan under the microscope, but also, makes recommendations about best prescription drugs, drug problems and drug interactions, which are available to pharmacists and physicians.
The knowledge of the prescribed drugs is of utmost importance. People can easily access thousands of potential drugs in the market. Some random combinations of medications can have an enormously negative impact upon the health of consumers, making them horribly sick. As a result, medical costs spiral out of control. Many people have died an untimely death for consuming prescribed drugs that should not have been prescribed. Consumption of medicines inappropriately can also result in death. In some cases, drug utilization review board urges the pharmacists to speak to people when they are prescribed new medications. Although this will not entirely stop the consumption of potentially hazardous medicines, with a little bit of co-operation from the patient’s end, it will definitely help control the problem.
The Utilization review services include Prior Authorizations, reviewing of set quantity limitations and application of step therapy program. They track, flag and report on prescription drugs that need more scrutiny, thus enabling significant savings for both the member and payer.
All exception requests are processed within a standard time period of 48 hours, whereas expedited ones are processed faster, within 24 hours. The final decision or outcome is usually forwarded to the prescribing physician and pharmacist for their discretion.
Utilization review is the prime source of utilization management, which gauges and evaluates the suitability, aptness, medical need as well as competence of health care services procedures and facilities in terms of the established criteria or guidelines of an applicable health benefits plan. It begets new activities or decisions based upon the scrutiny of a case.